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Prince Edward Islanders scored a D for overall health in a report card from the Conference Board of Canada.

It is the second time this week the province has performed poorly in a health report. Active Healthy Canada found low levels of physical activity in Island children.

Economic factors can make it difficult to improve health conditions, says Charlotte Comrie of the Heart and Stroke Foundation.

The Conference Board report card looked at a wide variety of indicators, from lifestyle to health system resources. The province scored well in some areas — with As in infant mortality, diabetes and access to hospital beds — but poorly in more. There were Ds in smoking, fruit and vegetable consumption, access to doctors and asthma and arthritis.

Health PEI Interim CEO Richard Wedge said the results were disappointing but not surprising.

The study suggests those poor choices create a burden on provincial healthcare. P.E.I. was not alone at the bottom. Manitoba, Saskatchewan and Newfoundland also received Ds.

Charlotte Comrie of the Heart and Stroke Foundation said personal choice is only part of the problem on the Island.

"It involves not just personal behaviours, but many social determinants of health as well such as education and income," said Comrie.

"To try and have government take on all the social determinants of health is complex for them."

The study's author said the province's health care system scored low partly because of a lack of services offered on the island. Every year the province spends $50 million on out-of-province treatment. Wedge said that has to change.

"Access to services is an important issue. So access to primary care, access to emergency rooms, access to hip and joint surgery, access to mental health services are all big," he said.

The province will release its own wellness strategy this fall. It will focus on improving the lifestyle of Islanders. Seeing the results of those efforts, however, could take many years.